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DocuSign Envelope ID: A899BEK- BAEC- 40F3 -91 E1- A9D77FC4C488 <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />Work Statement <br />r) Complete the Work Statement Chart to describe the work to be performed. <br />This chart is used to document program activities, program goals, performance measures, <br />and actual results. (Add more rows as needed) if this is a new program, you will only document <br />the projected information. Every program is required to have AT LEAST 1 Program Activity, <br />which should be SMART (§,pecific, Measurable, Achievable, Relevant, and Time - bound. Click <br />on SMART Goals to learn more. <br />• Program Activities should outline major activities the agency implements to accomplish its <br />program goals. (i.e. Deliver meals to elderly /disabled residents.) <br />• Program Goal should explain what the program is trying to achieve /accomplish. Goals are <br />statements about what the program should accomplish. (i.e. Deliver 100 meals per day, <br />Monday - Friday.) <br />• Performance Measures describe how you will evaluate the degree in which you achieved <br />the stated goals. (i.e. Will track the number of meals delivered each day.) <br />® Actual Program Results use program results to indicate the actual measurable achievement <br />of goals. if goals were not met, please explain. (i.e. Delivered an average of 105 meals per <br />day_) <br />Work Statement Chart for Program ECH Education Services <br />7. Program Activity Name <br />School Readiness- PreK Classroom <br />Program Goal <br />30 children 0 -5 will participate in the PreK Classroom <br />Performance Measures <br /># of children participating <br />Previous Year Program Results <br />45 children participated <br />Current Year Estimated Results <br />30 Goal for the year; 24 have participated as of 12/31/17 <br />Next Year Projected Results <br />At least 30 children <br />School Achievement- K -V grade TutoringlSummerGamp <br />$.: _:,Program.`A7Measures <br />30 children in K -8 will receive tutoring <br />Performa# <br />of children participating; percentage of improvement; parent pre -and <br />post - survey about tutoring impact on students. <br />Previous Year Pro <br />75 children participated <br />Current Year Estimated Results <br />30 Goal for the year; 12 children have been tutored since 12/31/2017 <br />Next Year Projected Results <br />At least 30 children. <br />PROGRAM INFORMATION 1/22/2018 10:14:21 AM Page 31 of 33 <br />